International Journal of Care and Caring • vol 2 • no 2 • 157–163 • © Policy Press 2018

Print ISSN 2397-8821 • Online ISSN 2397-883X • https://doi.org/10.1332/239788218X15262039552552

THEMED ISSUE • Variations and innovations in care and care work: Critical perspectives

editorial
Karen Christensen, Karen.Christensen@uib.no
University of Bergen, Norway

Yueh-Ching Chou, choucyc@ym.edu.tw

National Yang-Ming University, Taiwan

To cite this article: Christensen, K. and Chou, Y.C. (2018) ‘Editorial’, International Journal of Care
and Caring, 2(2): 157–63, DOI: 10.1332/239788218X15262039552552

Welcome to this themed issue on ‘Variations and innovations in care and care work:
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38

critical perspectives’, which we think provides new and interesting knowledge about
some of the important changes taking place in different parts of the world regarding
formal (publicly organised) care services, ‘informal’ care work within families and
networks, and the relationship between formal and informal care. Two central changes
Copyright The Policy Press

triggering the development of variations and innovations are the demographic

Delivered by Ingenta

issue of a worldwide ageing population and the idea, related to welfare services
in general, of changing the role of welfare users from mere ‘receivers’ of help to
more ‘responsibilised’ and/or independent users. These changes have stimulated the
development of arrangements outside the welfare state, or with the state less directly
involved in the provision of services. In some cases, they have also led to the inclusion
of migrant care workers in the workforce as a response to pressures on care services
from growing numbers of older people with support needs. The changes have also
stimulated innovative, and sometimes historically new, ideas or a renewed focus: user
involvement/participation (and the involvement and participation of carers); ideas
about independent living for service users; and user empowerment. Together, these
changes have promoted, or been linked to, policies of marketisation (with for-profit
actors providing care services) and personalisation (services adapted to individuals,
rather than individuals adapted to services). More broadly, the implications of these
changes are that care and care work are becoming increasingly diverse, blurring types
of care earlier seen as separated, especially between ‘informal’ and ‘formal’ care. How
variations in care and care arrangements and innovative ideas about care arise depends
on country contexts, however, which provide varying political, economic and moral
grounds for these developments.
Our themed issue of the International Journal of Care and Caring discusses
developments in a range of different countries, including the Czech Republic,
Germany and Switzerland, England, Canada, Taiwan, Finland, Norway, and
Australia. It covers three topics relevant to these variations and innovations. First,
new care relations (between carers and users of care services) develop when users are
encouraged, enabled or ‘pushed’ towards living independent lives. Second, variations
arise when care arrangements are in transition, mainly (but not only) on a macro-societal
level. Third, variations in care work are taking place in private households, stimulated

157
 Karen Christensen and Yueh-Ching Chou

by ideas about ageing in place, in which the home is seen as the best place to stay
when support and care are needed in managing everyday life.
Our first article, ‘Metaphors to work by: the meaning of personal assistance in
England’, by Tom Shakespeare, Andrea Stöckl and Tom Porter (University of East
Anglia, UK), offers insights into the important, and increasing, emphasis on services
that can empower users by offering and encouraging choice and control. Personal
assistance is an arrangement that has developed out of the agenda of personalisation
policies, but, importantly, it has also been developed through the disabled people’s
movement’s struggle for control and independent living. Internationally, the
arrangements that have created ‘personal assistance’ roles are referred to as ‘cash-for-
care’ systems (Ungerson and Yeandle, 2007) because the care user employs her or his
own care worker(s). Shakespeare, Stöckl and Porter focus on ‘direct payments’, an
English variation of ‘cash-for-care’, in which some disabled people directly employ
their own personal assistants. The authors use qualitative data from interviews with
both disabled employers and personal assistants, arguing that the personal assistance
arrangement represents an innovative, and still relatively new, way of organising
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38

services but has no fixed meaning for the employer–personal assistant relationships
that constitute personal assistance. They use the idea of metaphors to understand
these new relationships. Metaphors are familiar concepts in people’s ‘baggage’, but,
at the same time, they allow them to communicate new experiences in concrete
Copyright The Policy Press

ways. While other studies of personal assistance relationships have found plural ways
Delivered by Ingenta

of describing them, these authors contribute to the discussion in a new way, with
the help of the metaphor concept. They find personal assistance experiences are
expressed as ‘extending hands and legs’, ‘staff’, ‘colleagues’, ‘professionals’, ‘paid
friends’ and ‘family’. However, while they promote the multiple meaning of personal
assistance – stressing the many and varied roles and relationships evident in their
data and analyses – they also find that the risks of exploitation are greatest when
the ‘extension’ and ‘staff’ metaphors (for assistants) and the ‘family’ metaphor (for
both parties) are used. They suggest that more clarity is needed to understand how
metaphors shape roles and expectations in personal assistant relationships, with more
training of both parties being a part of this.
Three of our research articles shed light on care arrangements in transition. In the first,
‘Eldercare agencies and the marketing of care work in the Czech Republic: relieving
a family burden?’, Tereza Hronová and Adéla Souralová (Masaryk University, Brno,
Czech Republic) focus on private for-profit agencies providing in-home care for
older people in the Czech Republic – a development that represents a clear break
from the state-centred care system of the former communist period. The authors used
a qualitative approach, interviewing owners of private agencies and analysing their
websites to explore how these market-based services for older people are promoted,
and what kinds of care for older people they produce. They find that the agencies
present their consumer services as an option for families, relieving their ‘burden’
of care for older relatives, and relate this to the still strong familisation orientation
in Czech society. They report that the marketisation process that they have studied
objectifies older people and creates ‘depersonalised’ eldercare services. The article’s
critical approach to understanding the new process of marketisation in the post-
socialist Czech Republic makes the case for exploring marketisation processes in other
countries, focusing on contextual explanations for introducing consumer-oriented
services, as well as looking at their consequences for older people.

158
 Editorial

‘Long-term care and intermediary structures for frail older people: Switzerland
and Germany in comparison’, by Konstantin Kehl and Rahel Strohmeier Navarro
Smith (Zürich University of Applied Sciences, Switzerland), adds new knowledge to
the issue of blurring boundaries between informal and formal care, and how this can
create new types of care services with different functions in long-term care systems.
The authors use the concept of ‘intermediary structures’ to focus on the ‘in-between’
discussion in Switzerland (a country rarely included in European long-term care-
related analyses) and Germany. The term ‘intermediary structures’ refers to structures
within long-term care that are neither strictly institutionalised nor located in private
households, but create openings for care services, provided by professional staff,
where family-based care also takes place. These ‘in-between’ services include day and
night care, temporary (short-term) stays in nursing homes and respite care, and they
complement residential care, home care and family care. The authors explore why
and how such ‘intermediary structures’ have been located within the two countries’
current long-term care models. They find that although both are ‘conservative’
welfare regimes, facing the same challenges (an ageing population, increased female
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38

employment and increased pressures on family care), the intermediary structures

operate differently in the two countries. In Switzerland, they provide a ‘gateway’ into
the professional long-term care system, whereas in Germany, they function more as
a support to family care, complementing a welfare-mix orientation that encourages
Copyright The Policy Press

self-help and strategies of co-production between professionals, older people and

Delivered by Ingenta

their carers. The article thus highlights important differences and variations within
the ‘same’ welfare regime type.
While important variations can arise from marketisation and structures opening
up for a focus on ‘in-between’ services, to meet the challenges of ageing populations
and reduced family care, a further option related to the care workforce, and used in
many countries, is the inclusion of migrants. Li-Fang Liang (National Yang-Ming
University, Taiwan) pays attention to this, focusing on ‘Migrant care work in Taiwan:
applying a feminist ethics of care to the relationships of “live-in” care’. As in many
developed countries, care work in Taiwan is not very attractive for local people due to
its demanding physical, mental and emotional requirements, as well as low recognition.
One response to this has been the immigration of care workers from less wealthy
countries, in particular, Indonesia, the Philippines and Vietnam, often as ‘live-in’
care workers (who live in the household of the care recipient) and women. Drawing
on a case study comprising interviews with employers of ‘live-in’ migrants (mainly
adult children and in-laws of care recipients), participant observation in households
with live-in migrants and informal contacts with migrants and care recipients,
Liang questions what could be called the ‘exploitation’ approach. She argues that an
approach that views the use of migrant ‘live-in’ care workers as part of an unequal
Global South–Global North relationship leads to a rights and justice focus that sees
care workers as opposed to, and in conflict with, their care recipients. Based on her
case-study findings about mutual relations and interdependency between ‘live-in’
migrants and the older people they care for, Liang instead suggests that an ethics of
justice – with its individualistic orientation – can be replaced by an ethics of care
approach, in which human beings are seen as interdependent people, in both parts
of the care relationship, creating an ongoing cycle of ‘caring with’ people (Tronto,
2013). Liang suggests that this be made a public good, supported by the state.

159
 Karen Christensen and Yueh-Ching Chou

Our final two research articles shed light on care work variations taking place
in private households. The first, from Canada, focuses on support for carers who
combine full-time work in the labour market with (unpaid) care for older household
members (partners or parents), ‘Supporting carers in a remote region of Quebec,
Canada: how much space for social innovation?’, by Marco Alberio (University of
Quebec, Canada). Most carers are women, as is also the case in Alberio’s study. In
his article, he takes as the starting point that if no support is provided for ‘working
carers’ (who also do paid labour market work), those in the weakest positions will
need to reduce their market work or, in some cases, give it up, contributing to
greater inequality in society. The article is based on qualitative research: interviews
with carers, social workers who support carers (such as professional support in their
own households to carers of people with Alzheimer’s disease) and personnel in carers’
organisations. In Canada, the debate about how to support carers comes at the end
of the ‘Golden age of the welfare state’. It has a strong focus on welfare as a social
investment in society and on the debate about whether social innovations can respond
to needs that cannot be met by either the state or the market; it also takes account
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38

of the strengthening ageing-in-place policies in Canada. Support for carers – and

social programmes to develop this – is discussed as such a social innovation. Alberio
points out that carers were ignored for many years because the focus was almost
exclusively on older people needing care. When the focus turned to carers, however,
Copyright The Policy Press

major needs for emotional, practical and professional support were revealed, and
Delivered by Ingenta

the potential of social programmes to provide such support began to be recognised.

Alberio concludes that there remain serious challenges regarding work–care balance
for carers and a need for change in public policy on these social innovations, with
many more based on long-term planning and far less reliance on short-term projects.
The final research article in our themed issue is ‘Tensions and resilience: the
experiences of adult foster-care workers in Finland’, by Emilia Leinonen (University
of Jyväskylä, Finland). Leinonen focuses on an emerging care arrangement: adult
foster care for older people. While this has existed for three decades in Finland, it
has only recently come into focus in welfare discussions there as part of a search
for innovative care solutions that are less expensive than institutional care and that
strengthen the policies of deinstitutionalisation and ageing in place. Leinonen uses
a qualitative approach, drawing on interviews with long-term foster carers of older
people (as distinct from short-term or part-time placements) to understand foster-care
experiences as part of a ‘shared lives’ framework (Brookes and Callaghan, 2013). She
presents an interesting analysis, exploring both tensions within this kind of care work
and resilience (positive and negative aspects) in coping with long-term foster care.
While this ‘new’ type of care work takes place in the foster carers’ private households,
like ‘family’ care, in practice, it involves 24/7 (around-the-clock) care, although no
formal training is required to become a foster carer. A distinctive feature is that the
foster carer makes a contract with a municipality, and is then paid a monthly fee; this
means that the foster carer is not formally employed by the municipality. Leinonen
concludes that the tensions in adult foster care are very similar to those in other care
work (low recognition and reward, municipalities not treating them as genuine care
workers, and reduced social networks), and finds that foster carers have poor resources
to negotiate better working conditions with the municipalities. She also points out
that to sustain the positive aspects of this semi-formal care work – a relief from the

160
 Editorial

pressure and work pace of formal care work – it is crucial that Finnish municipalities
actively facilitate the resilience of foster-care workers.
Our ‘Debates and Issues’ section, which is free to view online, includes three
contributions: two from Norway and one from Australia. ‘From institutionalisation
via good intentions – and back again?’, by Bård K. Dahl (Senior Executive Officer,
Emma Hjorth Museum, Norway), describes historical changes in services for persons
with intellectual disabilities in Norway. These began as central institutions but later
– based on ideas about normalisation and social inclusion – promoted home-like
housing, the prototype for these consisting of group homes, which typically included
three to five disabled people. Using a range of concrete examples, and based on
personal experience, Dahl provides insights into some of the challenges behind the
good intentions of moving people from central institutions to their ‘own homes’. He
points out that some ‘home-like’ group homes have recently become bigger group
homes – once more pointing in the direction of a new type of institution – and stresses
new evaluations that show limited user participation and gaps in the professional
competence of staff in group homes. Dahl’s contribution provides a critical perspective
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38

on recent developments in welfare services for persons with intellectual disabilities in

Norway, a Nordic country known internationally for its generous welfare services.
Also from Norway is ‘User-controlled personal assistance – the case of persons
with intellectual disabilities’, by Anne-Britt Horn Hanssen and Sidsel Maxwell Grasli
Copyright The Policy Press

(respectively, Head and Senior Advisor, Olivia Assistance – an organisation promoting

Delivered by Ingenta

personal assistance for persons with intellectual disabilities). While the Norwegian
version of cash-for-care – user-controlled personal assistance – was first only offered
to and used by physically disabled people, disability organisations representing their
voices contributed to the extension of these (empowering) services to people with
intellectual disabilities. Using as an example a woman with intellectual disabilities
changing from traditional services to user-controlled personal assistance, the authors
argue for the importance of this development, not least as a way of avoiding ‘group
thinking’ about disabled people and potentially ignoring individual needs and
preferences in everyday life. As in the article by Shakespeare, Stöckl and Porter, this
item indicates that ‘innovation’ in personal assistance, and extending this arrangement
to disabled people who need support in their employer role towards personal assistants,
has further and perhaps unacknowledged dimensions.
From Australia, with its strong tradition of voluntary informal care and lesser focus
on public care (Mears, 2018), Fiona Burridge (Metro Access Officer, Maroondah City
Council, Ringwood, Victoria) contributes ‘Making a world of difference for carers:
the Pathways for Carers project’. This complements the discussion in Alberio’s article
about carers in Canada, and points to the need for, and importance of, supporting
carers. These are, in this project, (unpaid) carers – in the case described, carers of
someone with a disability or mental health problem of any age. Burridge provides
an account of the development, by different governmental and local actors, of the
Pathways for Carers project, which focuses on ‘carers’ walks’. The walks are advertised
through the Metro Access Officer’s database, local libraries, social media channels and
other channels, and aim to give carers a break from their caring role. Normally of
one hour, and designed to suit all fitness levels, the walks aim to break the isolation
that carers often experience, bring them into contact with other carers and – in a
wider perspective – educate and empower them to, eventually, make changes in their
lives. In Australia, which has a large number of carers and an evidence base which

161
 Karen Christensen and Yueh-Ching Chou

shows that social participation is significantly lower for carers than for non-carers,
the Pathway for Carers project offers an innovative caring-for-carers initiative, which
contributes to a more public focus on carers’ situation and highlights the importance
of recognising the enormous contribution that they make to the Australian economy.
Our book reviewers in this themed issue come from Asian and European countries,
and focus on an international approach. The first book reviewed, Disability and
technology: An interdisciplinary and international approach, by Alan Roulstone (University
of Leeds, UK), is reviewed by Doria Pilling (City University of London, UK). It
highlights the intersections between technology and disability, stressing that disabled
people and users of technology should be at the centre of the discussion, with
technology introduced for and by disabled and older people.
Social issues and policies in Asia: Family, ageing and work, edited by Raymond K.H.
Chan, Lih-Rong Wang and Jens O. Zinn (from universities in Hong Kong and
Taiwan), is reviewed by Hsiu-Jen Yeh (National Chung-Cheng University, Taiwan).
It covers debates and issues relevant to care and caring in Asian countries, such as the
relations between work and family, gender and equality, and ageing and migration.
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38

Comparative social policies and issues in different regions and societies of Asia are
also presented in this book.
Moving from Asia and its family care regimes to another continent and a different
care regime, our third review is of Long term care for the elderly in Europe, edited by
Copyright The Policy Press

Bent Greve (Roskilde University, Denmark). Reviewer Naonori Kodate (University

Delivered by Ingenta

College Dublin, Ireland) discusses this book’s presentation of case studies of 11

European Union member states to explore how their welfare states deliver long-term
care and the extent to which a social investment perspective is applied.
Our conference review is of the Transforming Care Conference, held 26–28
June 2017 in Milan, Italy, a conference of major interest for long-term care experts
worldwide. Entitled ‘Transforming care: innovation and sustainability’, it was the
third conference in this series, the previous ones having been held in Copenhagen
in 2008 and 2010. The present themed issue is based on one of the symposia of
this conference, and three of the research articles within it were presented at the
conference. Our conference review is by Paweł Łuczak (Poznań University of
Economics and Business, Poland), who draws on his knowledge as a care researcher
participating in the conference. His review highlights the content, inspiring debates
and rich discussions held in Milan, and notes that the fourth Transforming Care
Conference will be held in Copenhagen in 2019. The International Journal of Care and
Caring aims to collaborate with the conference organisers once again in 2019, and to
offer a symposium there to encourage both established scholars and new researchers
to engage with themes and topics of interest to the journal.
We hope you will enjoy reading this themed issue of the International Journal of Care
and Caring. Our thanks to Editor-in-Chief Sue Yeandle (University of Sheffield, UK),
her co-editors, in particular, Debates and Issues Editor Alisoun Milne (University
of Kent, UK), Book Review Editor Mary Larkin (The Open University, UK) and
Editor Kate O’Loughlin (University of Sydney, Australia), our peer reviewers for
articles in this issue, and the journal’s Editorial Assistant, Tom Hickman, for their
work in helping us realise this themed issue on ‘Variations and innovations in care
and care work: critical perspectives’.

162
 Editorial

References
Brookes, N. and Callaghan, L. (2013) What next for Shared Lives? Family-based
support as a potential option for older people, Journal of Care Services Management,
7(3): 87–94.
Mears, J. (2018) Reforms to long-term care in Australia: a changing and challenging
landscape, in K. Christensen and D. Pilling (eds) The Routledge handbook of social
care work around the world, London and New York, NY: Routledge, pp 303–15.
Tronto, J.C. (2013) Caring democracy: Markets, equality, and justice, New York, NY:
New York University Press.
Ungerson, C. and Yeandle, S. (2007) (eds) Cash for care in developed welfare states,
Basingstoke: Palgrave Macmillan.
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38
Copyright The Policy Press
Delivered by Ingenta

163
 Delivered by Ingenta
IP : 147.156.224.141 On: Wed, 10 Feb 2021 09:49:38
Copyright The Policy Press